Scleral fixation of a dexamethasone intravitreal implant in a case of subluxated bag–intraocular lens complex

Macular edema is a condition of retinal tissue treated with anti-inflammatory agents including placement of an intravitreal sustained-release dexamethasone device, designed to deliver a controlled amount of the medication for a prolonged time, representing an excellent therapy. Nonetheless, the implantation cannot be carried out without an anatomical barrier, such as the presence of posterior capsular support, lens, or intraocular lens. The absence of these barriers could lead to several complications, due to migration of the device from the vitreous cavity to the anterior chamber, causing corneal endothelial damage, corneal edema, glaucoma, and uveitis, among others. In consequence, a large number of patients cannot be treated with this useful surgical tool, resulting in chronicity of macular edema and severe visual acuity impairment. Therefore, we modified the conventional technique, through scleral fixation of the device providing a continuous delivering of dexamethasone, avoiding its migration to the anterior chamber in a patient without capsular support.